Austin Senior Living: Solved! a transcribed interview with Michael Gill, CEO Texas Senior Living Locators, interviewed by Grace Lanni, All About That Brand.
Grace Lanni: Michael, I’m happy to be with you today to talk about this important issue: When is the time right to move my loved one? I know you have great knowledge about senior living and Central Texas Facilities. Today you’re helping families place senior loved ones in Travis, Williamson, and Hayes counties, correct?
Michael Gill: That’s right. I help a couple hundred families a year with their placement needs, and memory care is a dominant theme.
Grace Lanni: I appreciate that you provide this service free to families. You are the go-to-guy here in Austin, Texas. There’s no doubt about it. You’ve spent years not only helping families place their family members, but also getting to know the different facilities in town. Would you say that’s accurate?
Michael Gill: It is. You know, from a dedicated Memory Care viewpoint, there are 56 different communities in Travis, Hays, and Williamson Counties. I’ve visited each one of them at least once, and most of them, a half dozen to a couple of dozen times. I’m in and out of these communities all the time taking people on tours. I have a very intimate knowledge of the facilities, and the personnel who work there.
Grace Lanni: Very interesting. So, assume I’ve done my homework, been to the doctor and have the requisite papers in order. What’s next?
Michael Gill: Well, a new, long term care home is always a difficult decision for a family. It’s always a highly personal and emotional decision for the family. I find that there are three rules that determine when a move is mandatory.
The first reason a move has to be made is if somebody is a danger to themselves. This danger can present in any number of ways. For example, someone may go outside to the mailbox to check the mail and not recognize which house is theirs. They could be out doing errands and get lost, or leave the stove on, or the water running. Often seniors are a fall risk, and you would hate it for them to be on the ground without assistance for any length of time. Sometimes, a person just shouldn’t be on their own because they’re a danger to themselves.
The second reason to move is because the person might be healthier someplace else. It doesn’t always mean they’re a danger to themselves, but they might not be taking their medications correctly, or there’s not a caregiver present that can help them with medications or meals or bathing. Maybe they’re becoming socially isolated being at home. If you are isolated, the big problem is you can’t quite figure out how to entertain yourself. Some people just end up staring at the walls or watching TV, but they’re not even processing what’s on the TV. The TV becomes noise. These are times when people need some stimulus from an outside person, and sometimes, they’re just not able to get that at the home.
The third reason that people need to move is when there are a caregiver issues. This often means a spouse is no longer able to take care of their loved one with dementia because they’re getting old themselves. In other cases when the children are caregivers and they have to work and can’t spend enough time with their parents. These are some of the reasons that people are inclined to move their family member. There are other ways to keep people at home. For example, you can hire outside caregivers, but these are often temporary solutions and they can be solutions that are much more expensive than moving somebody into a Memory Care home.
Grace Lanni: Ok, Michael, I’ve now checked the box for one or more of your three rules. How do you decide where to take my parent or loved one?
Michael Gill: There are three different criteria that people have to think about. Number one, ask what are the care needs of the future memory care resident? The second is the geographic location and the third is money. Unfortunately, memory care is very expensive and so money is often the first filter that we look at it when we go down the list of which facilities are possible solutions for your loved one. In Austin, TX, the median price in a dedicated Memory Care community is about $5,600 a month for a private room and maybe about $4,500 a month for a shared room. The least expensive Memory Care in town is about $3,500 in a shared room. If you try, you can spend more than $10,000 a month.
Cost is just one issue to look at if somebody’s looking for a dedicated Memory Care. The second thing is knowing that different types of dementia require different types of care. Perhaps your family member is a lovely lady who is very pleasant, though she is simply forgetful. All in all, she is not particularly difficult resident to take care of. This person could go to a larger assisted living, since many people with dementia need more socialization and activity. To truly thrive, a bigger place is often necessary. A different person may be more frail and require more hands-on assistance throughout the day; such a person may be better off at a smaller personal care home where the emphasis is on personal caregiving. We’re always looking for the Goldilocks solution, the just-right solution, meaning we’re trying to match the person’s personality to the personality of the memory care community, and consider what fits the patient’s needs. Some people need more outside space to wander in; others like to watch TV, and some prefer to do more arts and crafts. This type of questioning regarding someone’s personality drives the decisions regarding which type of community a family should explore.
We consider all the different nuances of a person and make the best to a facility that’s possible. Usually, I take people to three different places on tours because we want to show different options. From there, we hone in on what makes the most sense for them. These are the types of things we look at when placing a person in memory care. I certainly have been to all these places. I often will filter out some facilities I don’t like as much. These are the places where I don’t think that they have adequate staffing or where they’re just not as clean as they could be, or where I’ve heard of bad experiences from clients who are looking for a new community. By somebody like me, you’re already getting a guide who knows what’s important and has experience in these places. It’s a smart investment to visit multiple places – especially since the facility will pay my fee.
Grace Lanni: Michael, I love the fact that your service is free for the family, which definitely lightens the burden to engage you. The family will get awesome advice as they are looking to move someone in their family to memory care. Something like a caregiver ratio, you know, might not be as obvious or might not be shared with a client in the same way that you’re going to be aware. Do you have any examples or situations where you worked with the client and the caregiver ratio was not what you expected?
Michael Gill: Certainly. Caregiver ratios are something that always difficult get an apples to apples comparison. By definition, the caregiver ratio is how many caregivers there are to a certain population. If somebody had a population of 21 individuals and they had three caregivers, the ratio is seven residents per caregiver. However, not all caregivers are created equal. In some places, the caregivers also perform housekeeping duties. They mop, cook meals, do laundry, take out trash, and even clean toilets. Those are what we call “universal workers.” These types of workers have other work than just caregiving. A seven to one ratio where somebody is a universal worker doesn’t compare to another place where they have 21 residents and three caregivers, but they also have a housekeeping staff and a laundry staff, et cetera. Another trick that marketers may try to pull, which I don’t think is fair, is when they will include semi caregivers in their ratio. An activities director is not a true caregiver. Neither is the medication aide nor front office staff. Just because they have three people in the building doesn’t mean that they should be included in the caregiver ratio. I’ve had some places tell me that their caregiver ratio is four to one, but they were including the admissions officer and the executive director, neither of whom were even on the side of the locked door where the residents live. This isn’t an apples to apples comparison.
Grace Lanni: Interesting. Consider I’ve now identified the type of place where I’d like to move my family member. What’s next? How do I make the move happen?
Michael Gill: Well, the best way to do it is to visit multiple places of the type you’ve identified, in this case Memory Care communities. You don’t have to visit all 56 places in town to figure out what makes the most sense, because as we said, we would eliminate some locations using geographic or financial filters. If you and your family live in the far south part of town for example, you’re not going to go far north and farther away from family. We always try and place somebody as close as possible to their loved ones’ residence. If there’s more children, brothers, and sisters of the potential resident in the northwest part of town, that’s what we’re going to try and place them, even if the family member lived all their life in the south part of town. If we can find someplace that’s on a family member’s commuting route, that’s good too. I want to inspire more family visits, which are worth much more than community activities, as important as activities are.
Grace Lanni: What about the mechanics of actually making the move? I’ve selected the facility and made the down payment. What are the smart things to do to prepare to make the move?
Michael Gill: There are a couple of different things that go into the actual move. People get very nervous about actual moving day because they feel guilty about moving a family member into a home. This is a natural reaction, and I must say, when I moved my mother into memory care, I was nervous as a cat. It wasn’t a pleasant feeling. Ultimately, it was a great solution, but it didn’t feel like it at the time.
In terms of the move, there’s a lot of preparation prior to the move. This is true of all assisted living facilities. There’s a lot of paperwork to be done. You have to make sure that you have all of the prescriptions delivered to the memory care facility to the nurse in charge, so they can initiate medication management. You want to make sure that you have all the proper powers of attorney on file so that they can make sure that they know who to call and there is a medical problem. They want to know who’s going to be making payments, naturally.
You also need to fill out a lot of state mandated paperwork, including things such as to which hospital to transport your loved one in an emergency, etc. There’s an awful lot of paper work that goes on before you actually make the move, and it takes about 90 minutes to fill out.
On the day of the move, you will hire a mover as the rooms are not furnished by the memory care facility. Occasionally they are, but most of the time not. It is best for the resident to bring a lot of personalized items for the room. A comfortable pillow they’ve always liked is comforting. Lots of photographs and pictures of loved ones help so when they do arrive into their room, they feel as comfortable and as loved as possible. This reduces the anxiety as much as we’re able to.
Then the last thing: how do you get them to the facility? There are a variety of tactics. Most of the time, somebody just puts in the car and they drive them over. How do you leave, and who’s the right person to drive them over? I’ve had most instances where a spouse does not attend moving day. One of the children who has a good relationship with the parent will drive them. This reduces some of the emotional strain on the loved ones. Usually the facility will get the new resident involved in an activity as soon as they arrive so that the family member can slip out quietly.
Now there’s always a question, should you visit the loved one frequently when they’re doing the transition or should they stay away? That’s a personal decision and that’s something where the memory care facility will provide guidance. This very dependent on the resident’s personality, etc. The first couple of weeks are difficult for everybody because there are a lot of adjustments, and stress all around. A spouse may be grieving the loss of her husband who had to move into memory care, and she’s at home with way too much time on her hands. A child is feeling very guilty about doing this to their parents, even though it’s in everyone’s best interst.
Of course, the person moving into memory care is trying to get adjusted to an unfamiliar environment. Even the staff of the memory care facility is trying to figure out how to best deal with and make the resident happy. It usually takes three weeks or so for somebody to adjust comfortably. Sometimes, it takes longer, but it’s best to give the memory care place a chance to work what magic they can and get everybody adapted. Separation anxiety is almost similar to dropping off a child at kindergarten for the first time. It’s not an easy process, but it’s one that is best for your family member.